Whose Drug Problem?

There's a scene in his book Amexica: War Along the Borderline in which journalist Ed Vulliamy tiptoes through the bloody aftermath of a massacre at a drug rehabilitation center in Juarez, Mexico. Gunmen, likely tied to drug cartels, spared no one as they sprayed bullets up and down the center's hallways.

Only two weeks earlier, on Sept. 3, 2009, a total of 18 former drug addicts were murdered at a different rehab center in that city, in a similar fashion.

The trend hasn't stopped, with addiction center killings occurring as recently as last month. There are a host of theories as to why the slayings may occur -- turf wars, owed money -- but nearly all of them still remain unexplained.

From an outsider's perspective, the cartels seem to be sending a message: stay addicted. They want to keep their countrymen hooked in order to feed their economy. Addiction rates, then, must be raging in Mexico, and spiraling out of control. Right?

One national report from 2008 seemed to say so. It showed a 51% increase in the number of Mexicans self-reporting as addicts from a previous study six years earlier.

But a recent commentary in the Lancet says that's not the case. Author Mary Cuddehe points out that the report found just 5.2% of Mexicans experimented with illegal drugs, while a WHO report issued around the same time found that 42% of Americans experimented with marijuana, and 16% dabbled in cocaine.

Somewhat surprised about the statistics, I started asking around. Michael Escamilla, MD, chair of the psychiatry department of Texas Tech University in El Paso -- right across the border from Juarez -- said there's no doubt that addiction rates in Mexico are much lower than those in the U.S.

Escamilla pointed to his own research among Hispanic schizophrenia patients in Mexico, southern Texas, and southern California. Being born in Mexico and still living there was "protective" against higher rates of abuse, he and colleagues reported last year in Schizophrenia Research. Those who migrated to the U.S. were more likely to abuse drugs, and those born in the U.S. had the highest rates of all.

In Mexico, addiction rates "are increasing, but they are still low -- especially compared to countries like the U.S.," Escamilla told me.

It makes sense. More Mexicans than Americans live in poverty. The narcos can fetch a higher price for their product across the border (and researchers tell me that cheap inhalants -- sniffing glue or paint, for instance -- are the more popular drugs among Mexican young people).

But Luis Carcoba, MD, also a psychiatrist at Texas Tech in El Paso, who worked in Juarez for several years beginning in 2000, said the national rates aren't reflective of the situation along the border.

In Juarez, the proportion of people who've tried illegal drugs jumps four-fold, to nearly 20% -- a closer rival to U.S. experimentation rates. Numbers are likely similar in Tijuana, he said.

Getting treatment in these locations is also far more challenging than it is for anyone attempting to recover in the U.S. Although addicts here may have to deal with stigma, help-seekers in Juarez face severe intimidation.

Carcoba cites a close friend and official government source who prefers to remain anonymous: "He mentioned that after the massacres at the rehab centers, attendance at other centers declined about 35% to 40%."

Even when patients do make it to rehab centers, their treatment options are limited. Many receive psychotherapy alone, although Juarez now has four methadone clinics, Carcoba says. Other effective pharmacotherapies, like buprenorphine or naltrexone, are often too expensive.

Although the situation along the border seems to be growing more anarchic every day, John Roache, PhD, of the University of Texas Health Sciences Center in San Antonio, says it's clear that both countries' addiction woes would benefit from squelching Americans' thirst for drugs. That means putting better prevention programs and wider use of good treatment options at the top of the domestic agenda.

"We Americans shouldn't view Mexico as the drug-addicted state," Roache says. "The problem is here in the U.S."

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